Phimosis: pathological or physiological?

Mette Andersen Thorvaldsen & Hans-Henrik Meyhoff

[CIRP Note: This file contains the English
language abstract of an article that was published in
Danish.]

Background: Studies from England
indicate that only a minor part of boys referred for phimosis
had a real pathological stricture of the foreskin. Most of
them probably had a physiological narrowing of the prepuce.
The purpose of this study was to evaluate the normal
physiological condition regarding retraction of the prepuce
in childhood.

Materials and methods: Based on a
questionnaire study of 4,000 young men in Frederiksborg
County, Denmark, we evaluated the normal physiology of the
prepuce in childhood.

Results: Only 38% of those contacted
responded to the questionnaire. In newborns and in boys seven
years old, the prepuce could not be retracted in 22% and 21%,
respectively, compared to 7% at puberty. The boys themselves retracted the foreskin for
the first time at a mean age of 10.4 years. Problems
with the prepuce were reported by 23% but disappeared
spontaneously at a mean age of 13.3 years. Overall, 8% were
operated on on the foreskin at a mean age of 11.6 years, but
20% were not satisfied with the results. Furthermore, significantly more young men who
had their foreskin operated on had problems reaching
ejaculation and orgasm (p < 0005).

Discussion: Our results indicate
physiological phimosis to be a frequent condition that often
disappears by itself at puberty. Knowledge of normal
physiology of the foreskin is important, and treatment or
operation should probably await puberty.